Provider Demographics
NPI:1871625749
Name:BRENDA RICHARDSON MEMORIAL ACRE HOMES
Entity type:Organization
Organization Name:BRENDA RICHARDSON MEMORIAL ACRE HOMES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:SUZZETTE
Authorized Official - Last Name:WESTBROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-388-3545
Mailing Address - Street 1:5100 STAGE RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3161
Mailing Address - Country:US
Mailing Address - Phone:901-388-3545
Mailing Address - Fax:901-388-3423
Practice Address - Street 1:5100 STAGE RD
Practice Address - Street 2:SUITE #2
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-3161
Practice Address - Country:US
Practice Address - Phone:901-388-3545
Practice Address - Fax:901-388-3423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL3(20)4M3-066-6254251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services